Healthcare Provider Details

I. General information

NPI: 1215341961
Provider Name (Legal Business Name): KIMBERLY RIOS-LAM PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 LOCUST AVE
FONTANA CA
92336-3061
US

IV. Provider business mailing address

8010 LOCUST AVE
FONTANA CA
92336-3061
US

V. Phone/Fax

Practice location:
  • Phone: 909-684-0970
  • Fax:
Mailing address:
  • Phone: 909-684-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD7848720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: